MEDICARE: JUSTIN ELLIS GROSSMAN FICHTNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	90207	SC

General Provider Information

NPI Number	:	1285325431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN ELLIS GROSSMAN FICHTNER MD

Provider Business Mailing Address
First Line	:	145 SUNSET CT STE 100
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-2429
Country	:	US
Telephone Number	:	803-739-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 W MAIN ST STE 204
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2500
Country	:	US
Telephone Number	:	803-358-6420
Fax Number	:	803-358-6450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	06/12/2026

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